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Berglund E, Friberg E, Engblom M, Svärd V. Physicians' experience of and collaboration with return-to-work coordinators in healthcare: a cross-sectional study in Sweden. Disabil Rehabil 2024; 46:4120-4128. [PMID: 37772755 DOI: 10.1080/09638288.2023.2261851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE Return-to-work coordinators (RTWCs) give people on sick leave individualized support and coordinate between different stakeholders, including physicians. The aim of this study was to explore physicians' experience of RTWCs and investigate factors that influence how much physicians collaborate with RTWCs, or refer patients to them, in primary, orthopaedic, and psychiatric care clinics. MATERIALS AND METHODS Of the 1229 physicians responding to a questionnaire, 629 physicians who had access to a RTWC in their clinic answered to questions about collaborating with RTWCs. RESULTS Among physicians who had access to a RTWC, 29.0% collaborated with a RTWC at least once a week. Physicians with a more favourable experience of RTWCs reported more frequent collaboration (adjusted OR 2.92, 95% CI 2.06-4.15). Physicians also collaborated more often with RTWCs if they reported to often deal with problematic sick-leave cases, patients with multiple diagnoses affecting work ability, and conflicts with patients over sickness certification. CONCLUSIONS Physicians who had more problematic sick-leave cases to handle and a favourable experience of RTWCs, also reported collaborating more often with RTWCs. The results indicate that RTWCs' facilitation of contacts with RTW stakeholders and improvements in the sickness certification process may be of importance for physicians.
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Affiliation(s)
- Erik Berglund
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Emilie Friberg
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Monika Engblom
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Svärd
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Social Work in Health, Karolinska University Hospital, Stockholm, Sweden
- Department of Social Sciences, Division of Social Work, Södertörn University, Huddinge, Sweden
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Honkonen N, Lamminpää A, Liira J. Work ability meetings - Challenges and Resolutions, a survey to Finnish occupational physicians. Work 2024:WOR230331. [PMID: 38995747 DOI: 10.3233/wor-230331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Work ability meetings (WAM) are an essential and common tool of disability management in occupational health services in Finland. Meetings are held between an employee, a supervisor, and an occupational physician (OP). The aim is mainly to support work ability. OBJECTIVES To describe challenges and resolutions in the meetings as described by OPs. METHODS An internet survey was emailed to the members (n = 1304) of the Finnish Society of Occupational Health Physicians in August 2014. We asked physicians to describe those WAMs they had attended, especially challenges and resolutions concerning WAM. RESULTS A total of 302 (23%) OPs responded to the survey. Most severe of the challenges were personal conflicts and a lack of confidence between the parties at the workplace. Also, the participants' views may differ about the purpose and goal of the meeting. The respondents noted that the employer might be unable to organize modified work for disabled employees. As a resolution, OPs need to prepare well and maintain their professional and neutral role in WAMs in all cases. OPs also mentioned the need for training in insurance medicine and rehabilitation as well as skills as a mediator. CONCLUSIONS WAM is a potential tool for return to work and disability management in collaboration between employees, employers, and occupational health when all the participants reach a common goal and become aware of their role in the process. OPs need to recognize possible conflicting interests and contact each party before WAM. Keeping confidentiality in WAMs is a crucial matter.
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Affiliation(s)
| | - Anne Lamminpää
- Faculty on Medicine, University of Helsinki, Helsinki, Finland
| | - Juha Liira
- Faculty of Medicine, University of Turku, Turku, Finland
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Andersén Å, Carpentsier B, Berglund E, Carlsson M. Healthcare professionals' perceptions of the contributions of rehabilitation coordinators to patients in Swedish psychiatric care: a qualitative descriptive study. BMC Psychiatry 2024; 24:437. [PMID: 38867196 PMCID: PMC11167818 DOI: 10.1186/s12888-024-05895-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/06/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Rehabilitation coordinators have gradually been introduced into Swedish psychiatric care to support individuals on sick leave to return-to-work or enter work. AIM To explore healthcare professionals' perspectives on the contributions a rehabilitation coordinator can make to patients in psychiatric care. MATERIALS AND METHODS A descriptive qualitative design was used, and data were collected through interviews. Twelve healthcare professionals in psychiatric care participated in individual semi-structured interviews. Data were analysed using thematic analysis. RESULTS An overarching theme evolved: "The rehabilitation coordinator promotes security and reduces stress in the vocational rehabilitation process", based on two themes: (1) "Adaptations and support based on the patient's needs" and (2) "Rehabilitation coordinator efforts as relevant for care". The themes, in turn, consist of six subthemes. CONCLUSIONS This study showed that healthcare professionals perceived employment as important for patients' health and well-being. Therefore, the rehabilitation coordination efforts were not only seen as beneficial for addressing patients' challenges and needs in managing the vocational rehabilitation process but also as an integral part of the patient's care.
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Affiliation(s)
- Åsa Andersén
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22 UPPSALA, Sweden.
| | - Beatrice Carpentsier
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22 UPPSALA, Sweden
| | - Erik Berglund
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22 UPPSALA, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SE-171 77, Sweden
| | - Maria Carlsson
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22 UPPSALA, Sweden
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Svärd V, Arapovic Johansson Z, Holmlund L, Hellman T, Kwak L, Björk Brämberg E. Collaboration in the return-to-work process after sick leave due to common mental disorders: a qualitative study of stakeholders' views on goals and roles. BMC Public Health 2024; 24:1567. [PMID: 38862931 PMCID: PMC11165787 DOI: 10.1186/s12889-024-19063-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 06/05/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND This study explores how the goals of collaboration in the return-to-work (RTW) process for people with common mental disorders are described by the stakeholders involved, and how they experience stakeholders' roles and responsibilities in relation to these goals. METHODS Interviews were conducted with 41 participants from three Swedish regions. Nine of the participants were workers, six employer representatives, four occupational health professionals, four social insurance officers, 18 RTW coordinators and five physicians. Thematic analysis was conducted. RESULTS Three main themes and overarching goals when collaborating on RTW were identified. In the first theme, 'creating an informative environment', all stakeholders emphasised clear roles and responsibilities. The second theme, 'striving for consensus in an environment of negotiations', addressed negotiations about when and how to collaborate, on what and with whom, and reveal different views on stakeholders' goals, roles and responsibilities in collaboration. The third theme identified goals for 'creating a supportive environment' for both workers and other stakeholders. Coordinators are found to have an important role in achieving a supportive environment, and in neutralising power imbalances between workers and their employers and social insurance officers. CONCLUSIONS Competing goals and priorities were identified as hindering successful collaboration, contributing to a spectrum of complex versus easy RTW collaboration. This study suggests some basic conditions for achieving a collaborative arena that is neutral in terms of power balance, where all stakeholders can share their views.
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Affiliation(s)
- Veronica Svärd
- Department of Social Work, School of Social Sciences, Södertörn University, Huddinge, SE-141 89, Sweden.
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SE-171 77, Sweden.
| | - Zana Arapovic Johansson
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, SE-171 77, Sweden
| | - Lisa Holmlund
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, SE-171 77, Sweden
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, SE-141 83, Sweden
| | - Therese Hellman
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, SE-751 85, Sweden
- Department of Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, SE-751 85, Sweden
| | - Lydia Kwak
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, SE-171 77, Sweden
| | - Elisabeth Björk Brämberg
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, SE-171 77, Sweden
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Svärd V, Berglund E, Björk Brämberg E, Gustafsson N, Engblom M, Friberg E. Coordinators in the return-to-work process: Mapping their work models. PLoS One 2023; 18:e0290021. [PMID: 37561796 PMCID: PMC10414594 DOI: 10.1371/journal.pone.0290021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 07/31/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE In recent decades, many countries have implemented return-to-work coordinators to combat high rates of sickness absence and insufficient collaboration in the return-to-work process. The coordinators should improve communication and collaboration between stakeholders in the return-to-work process for people on sickness absence. How they perform their daily work remains unexplored, and we know little about to what extent they collaborate and perform other work tasks to support people on sickness absence. This study examines which work models return-to-work coordinators use in primary healthcare, psychiatry and orthopaedics in Sweden. METHODS A questionnaire was sent to all 82 coordinators in one region (89% response rate) with questions about the selection of patients, individual patient support, healthcare collaboration, and external collaboration. Random forest classification analysis was used to identify the models. RESULTS Three work models were identified. In model A, coordinators were more likely to select certain groups of patients, spend more time in telephone than in face-to-face meetings, and collaborate fairly much. In Model B there was less patient selection and much collaboration and face-to-face meetings. Model C involved little patient selection, much telephone contact and very little collaboration. Model A was more common in primary healthcare, model C in orthopaedics, while model B was distributed equally between primary healthcare and psychiatry. CONCLUSION The work models correspond differently to the coordinator's assignments of supporting patients and collaborating with healthcare and other stakeholders. The differences lie in how much they actively select patients, how much they collaborate, and with whom. Their different distribution across clinical contexts indicates that organisational demands influence how work models evolve in practice.
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Affiliation(s)
- Veronica Svärd
- Unit of Social Work, Department of Social Sciences, Södertörn University, Huddinge, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Social Work in Health, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Berglund
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Elisabeth Björk Brämberg
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Gustafsson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Monika Engblom
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Barriers, Facilitators and Experiences Linked to a Work-Related Case Management in Individuals with Substance Abuse Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148657. [PMID: 35886509 PMCID: PMC9315538 DOI: 10.3390/ijerph19148657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 01/25/2023]
Abstract
Individuals with substance abuse disorders experience trouble with the return to work or finding a stable workplace. At the same time, unemployment has negative effects on substance abuse. Work-related case management programs are often used to support the return to work in individuals with substance abuse disorders. This paper describes the experiences, perceived barriers, and facilitators, and their possible relations of people participating in a 12 month case management in Germany to support the return to work and to stabilize their workplace. For this purpose n = 15 interviews with the case management participants were conducted between December 2020 and September 2021. Data analysis followed a content analysis. The category system emerged is based on both the literature and the interview data. We describe several barriers and facilitators such as work motivation, experience with the case manager, and experience with the social security system. Furthermore, possible relationships between different barriers and facilitators are described. It will further be described how facilitators, especially the case manager, can help to overcome barriers, and how this might affect the intervention outcome.
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